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- � Permit No�-- - ------• -- -� \N ,�Ar ` APPLICATION FOR SANITATION PERMIT � (Complete in Duplicate � Date Issued Y-.?: - -�� ork herein escribed.-' r oa uin Local Health District for a perm�constru)and install the w 'A hcation is hereby made +o the San'Joaquin q ,Hance No. 549: � This application is made in compliance 0with Co'uunnty ---------------•--------------------•-------------------------------- 1 pp --------------- ry JOB ADDRESS AN LOCATION-__---d__� ------ { 0 Phone_ --(--��---' Owner's Name---- ------- - -------------------- Address ------Address------- -- ------- - ----- Contractor's Name--- �J ----------------- ----- ------------ ------- ------------------•-----.. Phone_.--------------•------------------ ------------------ lnstallatian will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ motel ❑ Other ❑ J `] - x ' -----------------------•- Number of living units: -_Y Number of bedrooms ---Z_ Number aths -__!__ Lot size .-_-T m Community system 0 Private Depth to Water Table -------- ft. _755- Water Supply: Public system ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: Yes ❑ No New Construction-. Yes R11"No ❑ t TYPE:OF INSTALLATION AND SPECIFICATIONS: 00 feet. ( (No septic tank or cesspool permitted if Pub li sever is available within 2 Li uid depth__Ma _-I----------6Capacity---- --Q, Septic --- /Tank: Distance from nearest well___ --__i,__Dista cp fro tfoun Pion_ __ No. of compartments._______----- / Si,e__h- q f T � �i �� cDistance to nearest lot lin __�� Disposa/Field: Distance from nearestjweI_G`J_-0---.-Distance from foundati n__f_____ --j--'r ----------- __ Len th of each line__ �- fWidth of trench--------- -------------Number of lines__________ ___ g } i Type of filter materia epth of filter materia Type ---Total length._____-_---1_ ! l--•----•----- Distance from foundationDistance to nearest lot line---.------------- Seepage Pit: Distance to nearest well---------------------- Size: Diameter------------------------Depth--------------------• ❑ Number of pits-:---------- ------Lining material--.---------- Cesspool: Distance from nearest well_________________Distance from foundation-______-________--.Lining materia-________----------------- -----als. --DDepth_ -= ----------------------Liquid Capacity.---------------------------9 • ❑ Size: Diameter-- ------------------------------ p Privy: Distance from nearest well------------------------------' Distance from nearest building---------------------------------------------------- .1 -------------_--- . ---•---------------------------------------- ❑ Distance to nearest lot line--------------------------------------------------------- -------=------------------------•----- - F -•---'-'---- - Remodeling and/or repairing (describe):------------------------------- __.__.___ ----------------------------------------------- certify that I have prepared this application and that the work will be dn accordance with San Joaquin County p -----•---•---'--------------• - ---- - I --•----------------------------------:------------------ •--------------•---•---------- ---------------------------------------- ------------------------------------------------- --- my I hereby c y P P ordinances, State laws, and rules and regulations of the San Joaquin Local Health.District. �p ' (Owner and/or Contractor} (Signed)--- ---------------�--------...-----=----------- Title -- (Plot plan -showing size of lot, loco+ion of system in relation to wells, buildings, etc., can be placed on reverse side). „ i FOR DEPARTMENT USE ONLY _ DATE-------------------------------------------------- APPLICATION ACCEPTED BY___ DATE.. REVIEWED BY--------------------- ----- =---------------- ------------------------------------------- BUILDING PERMIT ISSUED_________________Z--/___ ---------------- -- --------------------------------- --------------------------------- Alterations and/or recommendations:----------------------------------------------------------- ...... ---- ------------------- ------------------------- _____________________________________________________________ -__...__.__.--___-___-___________-_.________--____--___.. ________________ _ S ( FINAL INSPECTION BY---------------- ------ D ate------------- - -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 134 South American Street 300 West Oak Street Trac California R Manteca, California y'. Stockton, California Lodi, California i r ES-9-2M 8.51 Revised W-2100